| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AFS AGENCY3 | 185 GENESEE STREET STE 210 UTICA, NY 13501 | EXCELLUS | $107K | $0 | $107K | 4.75% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: CROWN RISK MANAGEMENT LLC | 432 NORTH FRANKLIN ST. STE 20 SYRACUSE, NY 13201 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $50K | $0 | $50K | 10.00% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE ST STE 210 UTICA, NY 13501 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 11.44% |
| AFS AGENCY3 | 185 GENESEE ST STE 210 UTICA, NY 13501 | HM LIFE INSURANCE COMPANY OF NEW YORK | $2K | $0 | $2K | 10.00% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE ST STE 210 UTICA, NY 13501 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 7.16% |
| KEVIN EDWARDS3 | 8332 MOYER CARRIAGE CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $533 | $289 | $822 | 4.37% |
| MELISSA PINE3 | 334 GRAY STREET HERKIMER, NY 13350 | THE PAUL REVERE LIFE INSURANCE COMPANY | $618 | $90 | $708 | 3.76% |
| MEAGAN M MARTIN3 | 517 PARK AVENUE SYRACUSE, NY 13204 | THE PAUL REVERE LIFE INSURANCE COMPANY | $175 | $38 | $213 | 1.13% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $88 | $38 | $126 | 0.67% |
| BRIAN BEAUCHEMIN3 | 334 GRAY STREET HERKIMER, NY 13350 | THE PAUL REVERE LIFE INSURANCE COMPANY | $106 | $3 | $109 | 0.58% |
| MCKENZIE ASHLYN PINE3 | 405 WEST STREET HERKIMER, NY 13350 | THE PAUL REVERE LIFE INSURANCE COMPANY | $106 | $0 | $106 | 0.56% |
| TRISHA TYMINSKI3 | PO BOX 439 CONSTANTIA, NY 13044 | THE PAUL REVERE LIFE INSURANCE COMPANY | $69 | $0 | $69 | 0.37% |
| VALERIE CELI3 | 6530 LAKESHORE RD CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $22 | $0 | $22 | 0.12% |
| ANTHONY MATRONE3 | 4297 ROUTE 31 CLAY, NY 13041 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.02% |
| ALISHA K ROBINSON3 Filed as: ALISHA ROBINSON | PO BOX 272 OLD FORGE, NY 13420 | AFLAC | $520 | $224 | $744 | 7.10% |
| AFS AGENCY3 | 185 GENESEE ST STE 210 UTICA, NY 13501 | AFLAC | $275 | $0 | $275 | 2.62% |
| JEFFERY S. KOWALSKY3 Filed as: JEFFERY S KOWALSKY | 2530 CHURCH ROAD SAUQUOIT, NY 13456 | AFLAC | $273 | $0 | $273 | 2.61% |
| JOSEPH P CALARCO3 Filed as: JOSEPH CALARCO | PO BOX 130 AUBURN, NY 13021 | AFLAC | $226 | $37 | $263 | 2.51% |
| DAWN PELLERIN3 | 34 TAMARACK DR NEW HARTFORD, NY 13413 | AFLAC | $123 | $0 | $123 | 1.17% |
| LAURA BOHANNON3 | 23 S MARVINE AVE AUBURN, NY 13021 | AFLAC | $31 | $0 | $31 | 0.30% |
| EDWARD D YATES JR3 Filed as: EDWARD YATES JR | 2063 COUNTY ROUTE 8 OSWEGO, NY 13126 | AFLAC | $17 | $0 | $17 | 0.16% |
| STEPHEN CONNORS3 | 108 HUNTSHILL RD SYRACUSE, NY 13029 | AFLAC | $7 | $0 | $7 | 0.07% |
| BRAD JONES AND ASSOCIATES INC3 Filed as: BRAD JONES AND ASSOCIATES | 19 BRITISH AMERICAN BLVD LATHAM, NY 12110 | AFLAC | $5 | $0 | $5 | 0.05% |
| KELLY A IRVINE3 Filed as: KELLY IRVINE | 15801 WHITE ORCHID LN FORT MYERS, FL 33908 | AFLAC | $3 | $0 | $3 | 0.03% |
| KEVIN MURPHY3 | 11 WILLOWBROOK TER CLIFTON PARK, NY 12065 | AFLAC | $1 | $0 | $1 | 0.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK INC | 500 PLUM ST. SYRACUSE, NY 13204 | FIRST UNUM LIFE INSURANCE COMPANY | $16 | $0 | $16 | 3.86% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENEFIT SOLUTIONS, INC EIN 16-1171765 | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 115 CONTINUUM DRIVE LIVERPOOL, NY 13088 | $16K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 910 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 914 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS | 282 | $2.2M |
| Vision | HM LIFE INSURANCE COMPANY OF NEW YORK | 246 | $24K |
| Life insurance(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 147 | $54K |
| Short-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 2,974 | $497K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 147 | $35K |
| Prescription drug | EXCELLUS | 282 | $2.2M |
| Other(3 contracts, 3 carriers) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 2,974 | $543K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,974 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.